Friday, March 10, 2017

Petition: Medical Treatment; Adequate Supply: LNPP Plant Count Increase

Jason Barker - Medical Cannabis Patient & Organizer with LECUA Patient’s Coalition Of New Mexico LECUA_thc_cbd.png



dukecitywellness.blogspot.com

Tuesday, February 28th 2017


New Mexico State Department of Health
Medical Cannabis Advisory Board
Medical Cannabis Program
PO Box 26110
Santa Fe, NM, 87502-6110


Petition: Medical Treatment; Adequate Supply:
LNPP Plant Count Increase



Table of Contents
Pg.  1 Cover Page
Pg.  2 - 4 Petition Introduction
Pg.  4 - 17 Petition Purpose and Background
Pg.  17 - 20 Relief Requested In Petition
Pg.  20 References
Pg.  20-22 Appendix A/B

 

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Petition Introduction: Requesting the Medical Treatment; Adequate Supply:
LNPP Plant Count Increase

New Mexico’s medical cannabis history started in 1978, after public hearings the legislature enacted H.B. 329, the nation’s first law recognizing the medical value of cannabis. The New Mexico’s medical cannabis program (MCP)  is the only program in the U.S. that places sole responsibility for regulation on the state’s Department of Health. Doctors must comply with state requirements for patients to be considered for applying to the medical cannabis program.

The Santa Fe New Mexican reported on February 13th (2017) that the New Mexico Medical Cannabis program has grown dramatically from 9,000 patients in 2013 to more than 33,000 today. The Department of Health estimates approximately 500 to 800 new patients join the program weekly. The tremendous growth of the Medical Cannabis Program with new program participants, an increase of 75% during 2016, so that currently means we have almost 45,000 patients benefiting from medical cannabis. The medical cannabis program office is currently processing applications in a 12-14 day range and recommends submitting renewal and new patient applications a minimum of 60 days prior to expiration to allow ample time for processing. Due to the incredible growth in the medical cannabis program participants, there needs to be a clear increase to the plant count allowed for by the licensed producers from the Department of Health. In order for the Department of Health Medical Cannabis Program to allow for the beneficial treatment with medical cannabis, the Department must properly have “adequate supply”.

There are 35 licensed producers growing medical cannabis, operating 41 dispensaries around the state, and 23 of these dispensaries are located in the Albuquerque area.  Current state law does not limit the number of plants that can be grown by the state’s licensed producers. Each one of the licensed producers is can choose to grow up to 450 medical cannabis plants, the maximum allowed under the Department of Health program rules and regulations. The department may issue two classes of producer licenses; to a qualified patient who holds a valid personal production license and to a non-profit producer who operates a facility.

The 2016/17 licensure list for the medical cannabis program shows a total of 13,800 medical cannabis plants licensed by the 35 producers for the All patients in the program.  

In the Lynn and Erin Compassionate Use Act, (2007) the law states; The Secretary of Health shall establish an advisory board consisting of eight practitioners representing the fields of neurology, pain management, medical oncology, psychiatry, infectious disease, family medicine and gynecology. The practitioners shall be nationally board-certified in their area of specialty and knowledgeable about the medical use of cannabis. The members shall be chosen for appointment by the Secretary from a list proposed by the New Mexico Medical Society. A quorum of the advisory board shall consist of three members.
The advisory board shall:
A. review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis;
B. accept and review petitions to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the medical use of cannabis;
C. convene at least twice per year to conduct public hearings and to evaluate petitions, which shall be maintained as confidential personal health information, to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the medical use of cannabis;
D. issue recommendations concerning rules to be promulgated for the issuance of the registry identification cards; and
E. recommend quantities of cannabis that are necessary to constitute an adequate supply for qualified patients and primary caregivers.

First, do no harm.  As an important step in becoming a doctor, medical students must take the Hippocratic Oath. And one of the promises within that oath is “first, do no harm”.  

Dr. William Johnson, former chair of the New Mexico Medical Cannabis Advisory Board in 2014 told KUNM public radio that many of the changes proposed by the Department of Health would hurt patient access to medical cannabis.  After the Rules and Regulations changes from the medical cannabis meetings in 2014 went into effect in February of 2015, the results for patients and caregivers in the program has been clearly harmful to patient well being and overall program health. And it is the patient’s,  producers, and medical cannabis community members that are now paying the price in regards to health and financial costs.

We have a sound law in the Lynn and Erin Compassionate Use Act, yet we are unable to provide “adequate supply” and it can not be properly defined by the Department by using unknown variables it has not collected then this leads to further examination of how these definitions pertaining to adequate supply were determined in the past years.

In order for the Department of Health Medical Cannabis Program to allow for the medical treatment of cannabis, the Department must properly have “adequate supply”.  For the Department to have “adequate supply” they would need to know the different amounts of plant material that goes into all the different types of medicine being produced in the MCP. Dried cannabis flower (bud), pre-rolls, edibles, tinctures, topicals/salves, and concentrated forms of cannabis- all require different amounts of cannabis plant material to produce. This is empirical data that has not been collected, studied or researched within the state’s medical cannabis program by the Department of Health.

The current law for the Medical Cannabis Program, passed in 2007, states the following, (Page 1/Section 2) “PURPOSE OF ACT.--The purpose of the Lynn and Erin Compassionate Use Act is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments.”

Mosby’s Medical Dictionary states that “medical treatment” means; the management and care of a patient to combat disease or disorder. Medical treatment includes: Using prescription medications, or use of a non-prescription drug at prescription strength; and or treatment of disease by hygienic and pharmacologic remedies, as distinguished from invasive surgical procedures. Treatment may be pharmacologic, using drugs; surgical, involving operative procedures; or supportive, building the patient's strength. It may be specific for the disorder, or symptomatic to relieve symptoms without effecting a cure.(Mosby's Medical Dictionary, 9th edition.)

What is a chronic medical condition?
A chronic disease is one lasting 3 months or more, by the definition of the U.S. National Center for Health Statistics. Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear. Harvard Medical Dictionary defines chronic as: Any condition that lasts a long time or recurs over time; chronic pain as: Pain that persists after an injury has healed or a disease is over; and chronic pain syndrome as : Long-term, severe pain that doesn't spring from an injury or illness, that interferes with daily life, and is often accompanied by other problems, such as depression, irritability, and anxiety.
What is the meaning of debilitating?
Something that's debilitating seriously affects someone or something's strength or ability to carry on with regular activities, like a debilitating illness. Debilitating comes from the Latin word debilis, meaning "weak." That's why you'll often see the adjective used to describe illness, despite the negative reference.
Petition Purpose and Background

The purpose of this Medical Treatment petition is for addressing; Medical Treatment; Adequate Supply:LNPP Plant Count Increase.

The MCP should have a Plant Count that is based on ratio of patients to serve AND inclusion of empirical data for varying amounts cannabis plant material needed to manufacture different forms of medical cannabis medicine.
This petition for the Medical Treatment that pertains Petition: Medical Treatment; Adequate Supply:
LNPP Plant Count Increase, is being provided to bring the state Department of Health Medical Cannabis Program in compliance with the Lynn and Erin Compassionate Use Act.

Removing CBD strains from cannabis plants counts in New Mexico and other state programs for patients, caregivers and medical cannabis producers allowable plant count just makes sense. A patent was already awarded to part of the federal government, the U.S. Health and Human Services in 2003 (US6630507) that also covers the use of CBD as a treatment for various neurodegenerative and inflammatory disorders. Since cannabis contains medicinal compounds recognized and endorsed by an agency of the U.S. government- Why is it that cannabis remains on the Federal Schedule One list of drugs? The fact that CBD-rich cannabis is non-psychoactive or less psychoactive than THC-dominant strains makes it a great option for patients looking for relief without disconcerting feelings of lethargy or dysphoria.
Removing CBD plant strains from the state’s program plant counts would allow for the proposed 5 ounces monthly in adequate supply for patients.  This would also allow for patients with a personal production license to empower themselves and their own grows with more CBD cannabis plants. For the producer growing medical cannabis, this would allow for 500 THC medical cannabis plants while still being able to provide enough CBD medical cannabis plants - thus allowing for the growing what may $ell more and enable the CBD needs for patients to be easily achieved by producers.
Medical Cannabis CBD & Hemp CBD strains at ratio of;  1.5 thc (or lower) : 1 cbd (or higher) not be counted against total allowed medical cannabis plants for the Patient PPL, Caregiver PPL, and the LNPP allowable plant count. And the establishment of an monthly allotment for Clones and Cuttings provided to qualified patient / caregiver with a PPL by a LNPP’s not counted against LNPP allowable plant count.

So what is the right plant count and adequate supply for the New Mexico medical cannabis program?
Some states have restrictions on the number of plants producers are allowed to have and other states such as Nevada and Arizona have none. California and Washington limit the square
footage of plant production facilities and other states such as Delaware, Hawaii, Maine, and New
Hampshire limit plant counts based on patient need.
Above is the ratio of stem, leaf and bud that NIDA and the DEA documented.

How much of the cannabis plant is useable medicine? (The flower or bud)
Chris Conrad, former director of Safe Access Now, author and court-qualified cannabis expert did a research study “Cannabis Yields and Dosage: A Guide to the Production and Use of Medical Marijuana”. This information is current as of April 15, 2015.
Cannabis takes root as either seedlings or cuttings (clones). Later, male plants are cut out of the garden to prevent pollination. Female plants grow to full maturity before being cut and harvested. About 75% of the fresh weight is moisture that is lost in the drying process. Almost half the dry plant matter is stem; only about a quarter (18% to 28%) remains after the herb is cured and manicured into medical-grade flower that has a coating of resin glands with cannabinoids, the active compounds. Contrary to cannabis’ reputation as a weed, it is not so easy to grow quality medicine. Not all gardens have ideal conditions and few patients are trained botanists.

Federal cannabis yield study
Ratio of sinsemilla bud to leaf, excluding stems and branches.
The canopy size predicts yield
The US Drug Enforcement Administration (DEA) conducted scientific research with the National Institute on Drug Abuse (NIDA) at the University of Mississippi, published in the 1992 DOJ report, Cannabis Yields. Both seeded and sinsemilla plants of several seed varieties were measured. The NIDA data in Table 3 includes leaf with the bud, and therefore requires an additional adjustment to arrive at the true garden yield below.
Canopy is a term used in agriculture to describe the foliage of growing plants. The area shaded by foliage is called the canopy cover. The data on this page are based on the higher yielding, more potent seedless buds, sinsemilla. The federal field data show that, on average, each square foot of mature, female outdoor canopy yields less than a half-ounce of dried and manicured bud (Table 4), consistent with growers’ reports and gardens that have been seized by police as evidence and I have later weighed and examined.
All other things being equal, a large garden will always yield more than a small one, no matter how many plants it contains. This is true for skilled and unskilled gardener alike. Restricting canopy will therefore limit any garden’s total bud yield, no matter which growing technique is used or how many plants make up the combined canopy cover. Most patients can meet their medical need with 100 square feet of garden canopy.
Above is the amount of leaf plus bud produced on the average federally grown marijuana plants.
After you remove the stems, the ratio of leaf to bud is shown above. This ratio applies to the data in Table 3; multiply those figures by 0.48 to get the amount of mature female flowers, or "bud," as shown below.
Facts About The Medical Conditions That Qualify For The Medical Cannabis Program.
Patients in New Mexico diagnosed with one or more of the following medical conditions qualify into the program and are allowed legal protection under the Lynn and Erin Compassionate Use Act:
Amyotrophic Lateral Sclerosis (ALS) : Can't be cured, but treatment does help. Chronic: lifelong.
Cancer : Chronic disease, can be treated, & average treatment plan length 5 years or more.
Crohn’s Disease : Can't be cured, but treatment does help. Chronic: Lasting several years or lifelong.
Epilepsy : Is a chronic neurological disorder. Can't be cured, but treatment does help.
Glaucoma : Chronic, can't be cured, but treatment does help.  ( Can braille cards be printed ? )
Hepatitis C : Chronic, but treatment does help.
HIV/AIDS : Can't be cured, but treatment does help. Chronic: lifelong.
Huntington’s Disease : Can't be cured, but treatment does help. Chronic: lifelong.
Hospice Care :Palliation of a chronically ill, terminally ill or seriously ill patient's pain and symptoms.
Inclusion Body Myositis : Can't be cured, but treatment does help. Chronic: lifelong.
Inflammatory Autoimmune-mediated Arthritis Can't be cured, treatment does help. Chronic: lifelong.
Multiple Sclerosis Can't be cured, but treatment does help. Chronic: lifelong.
Damage to the nervous tissue of the spinal cord :No cure, treatment does help. Chronic: lifelong.
Painful peripheral neuropathy :Can't be cured, but treatment does help. Chronic: lifelong.
Parkinson’s disease :Can't be cured, but treatment does help. Chronic: lifelong.
Post-Traumatic Stress Disorder (PTSD) :Can't be cured, but treatment does help. Chronic: lifelong.
Severe Chronic Pain :Can't be cured, but treatment does help. Chronic: lifelong.
Severe Anorexia/Cachexia :Often a sign of disease, such as cancer, AIDS, heart failure, or advanced chronic obstructive pulmonary disease (COPD). Chronic but treatment does help.
Spasmodic Torticollis (Cervical Dystonia) :Can't be cured, but treatment does help. Chronic: lifelong.
Ulcerative Colitis: Can't be cured, but treatment does help. Chronic: lifelong.
All of these types of debilitating medical conditions have some common medical facts; treatment plan for 5 years if not lifelong, most all have no cure, all of them are chronic health conditions, and sadly some take a person’s life. They all also require a medical treatment plan with several visits to more than one medical practitioner throughout the course of a year.
For those rules and regulations that have been established limiting patients and primary caregivers to; “Pursuant to Department rule, a personal production license holder may possess no more than four (4) mature cannabis plants (flowering) and twelve (12) immature plants (non-flowering and male plants). A qualified patient may also possess no more than 230 units of usable cannabis within a three-month period. A unit is defined as one gram of dried usable cannabis plant material, or 0.2 grams (200 milligrams) of THC in a cannabis-derived product.”.  This current format being used by the Department of Health Medical Cannabis Program in devising adequate supply does not allow for the beneficial use of medical cannabis. This in fact prevents patients from fully being able to alleviate symptoms caused by debilitating medical conditions and their medical treatments and that creates a liable situation for the state being out of compliance with the LECUA, 2007.  

How Is The Medical Cannabis Program Out Of Compliance With The LECUA, 2007?  

For  example, a cancer patient in the medical cannabis program, to be able to receive beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments under the current law; cancer patients would need to be allowed to posses a minimum quantity of usable medical cannabis of 425.243 grams per 3 months (or 2.5 ounces every two weeks). For this patient scenario, in the patient having a PPL - the addition of two more medical cannabis plants or Patient / Caregiver safe access to medical cannabis via LPPC, would allow for this treatment. (Patient / Caregiver PPL plant count increased to allow for 6 immature seedlings /clones / cuttings, 6 plants in vegetative stage, and 6 plants in flowering stage for total of 18 cannabis plants. )
Types of medicine made from the medical cannabis plants for treating cancer is a concentrated medical cannabis oil. A three month supply of this concentrated medical cannabis oil requires 450-500 grams (or Units) of dried cannabis flower plant material.  (The oil is also known as, hemp oil, Phoenix Tears, and Rick Simpson Oil (RSO), whole-plant cannabis oil can be orally administered or applied directly to the skin. Sublingual delivery is the preferred method of treatment for many cancer patients.)
To understand how cannabis oil, or Rick Simpson Oil (RSO) and CBD oil are different, one must first understand that there are many different types of CBD oil currently available on the market.
The first type of CBD oil is whole-plant oil derived from the highly resinous buds of the cannabis plant and is only legal in MMJ-friendly states because it contains other minor cannabinoids (although CBD is the most abundant cannabinoid in these types of products).
The second type of CBD oil is usually marketed as legal across all 50 states and typically sources industrial hemp (non-psychoactive cannabis hemp stalk with < .03% THC). CBD oil derived from hemp stalk/seeds is not the preferred oil choice for many medical marijuana patients looking to treat a specific ailment or health condition because it lacks other cannabinoids like THC that have significant medical benefits.
Along with the massive medicinal benefits of CBD oil, RSO also contains THC and other key cannabinoids resulting in patients having a much more euphoric medicating session than if they took CBD oil on its own. Research has found tetrahydrocannabinol (THC) to offer very promising therapeutic benefits for many conditions. This is one reasons some patients prefer whole plant cannabis oil over individual cannabinoids. ( Source )

A 30 day supply of cannabis oil is 60 grams or ml of oil with a dose of 2 grams or ml per day. It requires 450-500 grams of dried cannabis flower plant material to make high quality cannabis oil. So a 90 day supply or three months is 180 grams or ml of oil or 1425 grams of dried cannabis flower plant material ( Source: Rick Simpson ). Those rules and regulations that have been established limiting patients and primary caregivers to having only 16 medical cannabis plants with only 4 in flower for a PPL, and the limit to 230 Units (grams) of any amount of medical cannabis for a three month period does not allow for the beneficial use of medical cannabis and further prevents the purpose of the law to be fulfilled as stated in section two. This also does not allow for the beneficial use of medical cannabis for other medical cannabis medicine products like tinctures and medibles, which further prevents the purpose of the law to be fulfilled.

Medical cannabis patients registered in the New Mexico MCP use the different kinds of cannabis oil with all types of conditions including, but not limited to, Amyotrophic Lateral Sclerosis (ALS), Cancer, Crohn’s Disease, Epilepsy, Glaucoma, Hepatitis C, HIV/AIDS, Huntington’s Disease, Hospice Care, Inclusion Body Myositis, Inflammatory, Autoimmune-mediated Arthritis, Multiple Sclerosis, Damage to the nervous tissue of the spinal cord, Painful peripheral neuropathy, Parkinson’s disease, Post-Traumatic Stress Disorder (PTSD), Severe Chronic Pain, Severe Anorexia/Cachexia, Spasmodic Torticollis (Cervical Dystonia), Ulcerative Colitis, arthritis, diabetes, depression, osteoporosis, psoriasis, insomnia, asthma, burns, migraines, regulation of body weight, chronic pain, and mutated cells (polyps, warts, tumors).

Those rules and regulations that have been established and the current plant count format being used by the Department of Health Medical Cannabis Program in devising adequate supply does not allow for the beneficial use of medical cannabis. This in fact prevents every patient in the MCP from fully being able to alleviate symptoms caused by all of the qualifying debilitating medical conditions and their medical treatments and creates a liable situation for the state being out of compliance with the LECUA, 2007. Even if the patient or primary caregiver is granted the “Medical Exception” and provided the additional 115 Units (or grams) for a total of 345 Units (or grams), the state and MCP would still not be in compliance with the LECUA law.

Using that formula you get the above amount of cannabis bud, expressed as dried and processed yield per square foot of mature female sinsemilla canopy.
For indoor cannabis cultivation, Ed Rosenthal, author of a number of books on cannabis cultivation, in evidence to the U.S. Congressional Sentencing Commission, stated that a mature cannabis plant grown under modern indoor conditions can usually be expected to yield 10 grams of marijuana (i.e. dried flowering tops), and that each "marijuana garden" should be treated on its own merits[xviii].  Knight et al[xix] grew plants hydroponically under optimum conditions with mesh support for branches (‘screen of green’) yielding a mammoth average yield of 687g per plant.  In more typical hydroponic growing conditions in the Netherlands Toonen et al[xx] reported an average yield of 33.78g per plant, and Huizer et al[xxi] reported an average 22g per plant. (Source: http://www.idmu.co.uk/cannabis-plants-cultivation-yields.htm )

In the Rule and Regulations for the Medical Cannabis Program, Title 7-Chapter 34-Part 2 Advisory Board Responsibilities and Duties defines Adequate Supply as the following:
 “Adequate supply” means an amount of cannabis, derived solely from an intrastate source and in a form approved by the department, that is possessed by a qualified patient or collectively possessed by a qualified patient and the qualified patient’s primary caregiver, that is determined by the department to be no more than reasonably necessary to ensure the uninterrupted availability of cannabis for a period of three months or 90 consecutive calendar days.
In the Rule and Regulations for the Medical Cannabis Program, Title 7-Chapter 34-Part 4: Medical cannabis licensing requirements for producers, couriers, manufacturers and laboratories states a “Personal production license” means a license issued to a qualified patient participating in the medical cannabis program, to permit the qualified patient to produce medical cannabis for the qualified patient’s personal use, consistent with the requirements of department rule.

7.34.4.8                 PRODUCER LICENSING; GENERAL PROVISIONS:
               A.            The department may license two classes of producers:
                               (1)           A qualified patient who holds a valid personal production license.  A qualified patient who holds a valid personal production license is authorized to possess no more than four mature female plants and a combined total of 12 seedlings and male plants, and may possess no more than an adequate supply of usable cannabis, as specified in department rule.  A personal production license holder may additionally obtain usable cannabis, seeds, or plants from licensed non-profit producers.  The primary caregiver of a qualified patient who holds a personal production license may assist the qualified patient to produce medical cannabis at the designated licensed location that is identified on the personal production license; the primary caregiver may not independently produce medical cannabis.
                               (2)           A non-profit producer that operates a facility and, at any one time, is limited to a combined total of no greater than 450 mature female plants, seedlings and male plants, and an inventory of usable cannabis and seeds that reflects current patient needs, and that shall sell cannabis with a consistent unit price, without volume discounts or promotional sales based on the quantity purchased.  A non-profit producer shall not possess a quantity of either mature female plants or seedlings and male plants that exceeds the quantities authorized by their licensure and associated licensing fee.  A licensed non-profit producer may sell and distribute usable cannabis to a person or entity authorized to possess and receive it. A licensed non-profit producer may obtain plants, seeds and usable cannabis from other licensed non-profit producers.

In the Part 2 of the Rules and Regulation (Title 7-Chapter 34-Part 2) are the following definitions:
                    “Unit” means a quantity of usable cannabis, concentrate, or cannabis-derived product that is used in identifying the maximum supply that a qualified patient may possess for purposes of department rules.
                   “Usable cannabis” means the dried leaves and flowers of the female cannabis plant and cannabis-derived products, including concentrates, but does not include the seeds, stalks, or roots of the plant.



Rules, Regulations, & Policy Solution For Adequate Supply
The approval of this petition: Petition: Medical Treatment; Adequate Supply:
LNPP Plant Count Increase, that is being provided to the state Department of Health Medical Cannabis Program so the advisory board can review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis with the Lynn and Erin Compassionate Use Act. The approval of this petition would bring the Department of Health in compliance with the intent of the law and uphold the spirit of the Lynn and Erin Compassionate Use Act, 2007. Fulfilling both;“ Section 2. PURPOSE OF ACT.--The purpose of the Lynn and Erin Compassionate Use Act is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments” And  Section 6. ADVISORY BOARD CREATED--DUTIES.
During the legislative session, Senate Bill 177 was introduced by Senator Cisco McSorley, the bill would have removed Department of Health’s authority to determine by rule “adequate supply”of medical cannabis.

Option A For A LNPP Plant Count Increase:
The bill sets licensure fees of $30 thousand for the first 150 plants, $10 thousand for each
additional 50 plants, and a licensure fee limit of $90 thousand. Additionally, the bill sets
statutory limits on the possession of medical cannabis as listed in the table below.
Licensed producer shall possess no more than the following
amounts:
(1) when the current census is thirty-five thousand qualified patients, a licensed producer shall possess no more than five hundred cannabis plants;
(2) when the current census is forty thousand qualified patients, a licensed producer shall possess no more than six hundred cannabis plants;
(3) when the current census is forty-five thousand qualified patients, a licensed producer shall possess no more than seven hundred cannabis plants;
(4) when the current census is fifty thousand qualified patients, a licensed producer shall possess no more than eight hundred cannabis plants;
(5) when the current census is fifty-five thousand qualified patients, a licensed producer shall possess no more than nine hundred cannabis plants;
(6) when the current census is sixty thousand qualified patients, a licensed producer shall possess no more than one thousand cannabis plants; and
(7) when the current census is sixty-five thousand qualified patients, and for every census increase of five thousand qualified patients, the department shall increase the total allowable plant count by one hundred additional cannabis plants.

Plant Count For Producers Based On Patient Population Growth For Adequate Supply Proposed: Legislators and the Department of Health MCP & MCAB could easily solve this by looking to Americans For Safe Access for this policy.


Some states have restrictions on the number of plants producers are allowed to have and other
states such as Nevada and Arizona have none. California and Washington limit the square
footage of plant production facilities and other states such as Delaware, Maine, and New
Hampshire limit plant counts based on patient need.

Option B For A LNPP Plant Count Increase:
“Adequate Supply” can be achieved, if it is approached that the supply must be available if Every Patient ALL went out and purchased on the same day. ( About 3 plants per patient average based on 35,000 patients is 1000 plants per producer. ) And plants counts should be based on plant canopy and square footage versus counting individual plants.

For ensuring safe access to all areas of the the state of New Mexico and proper administering of the Lynn and Erin Compassionate Use Act, by the New Mexico State Department of Health, this can be achieved by opening applications for producer licensure specific to rural expansion in the state and by providing a new plant count structure to provide adequate supply as follows;  

First, not all medical cannabis plants are the same. The cannabis plant contains dozens of cannabinoids. The most well known cannabinoid for a long time has been tetrahydrocannabinol (THC), but as more scientific research is conducted involving cannabis and its ability to be used as a medicine, more and more people are learning about other cannabinoids, especially cannabidiol (CBD). Some plants have THC and others produce CBD, THC has psychoactive properties that affect your brain and give you a ‘runner’s high’ while CBD does not.

Making revisions to licensing requirements for medical cannabis licensed producers with a plant count for patients and producers properly structured and increased: Medical cannabis CBD strains at ratio of;  1.5 thc(or lower) : 1 cbd (or higher) should not be counted against patient or producer allowable plant count.  Medical cannabis clones and cuttings provided to qualified patient with a personal production license by a licensed producer should not count against the maximum allowable plant count.
A plant count that is based on ratio of patients to serve with inclusion of empirical data for varying amounts cannabis plant material needed to manufacture different forms of medical cannabis medicine.  
A plant count to provide a ratio of 3 THC medical cannabis plants per enrolled patient in conjunction with medical cannabis CBD strains having been removed from the plant count. And based on yearly program totals. Thus if there were 40,000 patients plus the 3 cannabis plants would equal 120,000 THC medical cannabis plants for 35 licensed producers equals 3,429 allowable medical cannabis plants (Minimum standard set by MCAB &  Plant Count adjusted yearly for program growth). Plant count increase structured to be 1715 plant increase by July 1st 2017 then another 1714 by July 1st 2018. Structuring this in phases will reduce the risk of crop problems and maintain high standards of quality for the medical cannabis plants.
   
Licensing fee structure changed and lowered to be as follows; the department shall assess a nonrefundable fee not greater than five hundred dollars ($500) for processing an application for a new or renewal license. For a new or renewal processor license, medical wholesale license or medical retail license, the department shall charge an annual license fee of not more than two thousand dollars ($2,000). For a new or renewal production license, the department shall charge an annual license fee of: Fifteen thousand dollars ($15,000), if the producer will possess up to one hundred fifty cannabis plants; and an additional five thousand dollars ($5,000) for each additional fifty cannabis plants the producer will possess.  And this also will prevent a small number of the licensed producers from cornering the market of medical cannabis.

The per plant fee would be $100 for medical cannabis plants containing a THC content above the provided CBD ratio.  Licensure limit established allowing one licensed producer to have one grow location per three dispensary store fronts whereas current rules and regulation do not limit this.  All current producers would be granted additional license(s) per application review and program performance standards met. A time period for new producers to open needs to be established; 90-120 window of days then letter sent providing a warning and 45 days time, then final letter sent providing 30 days before forfeiture of license. Currently 6 of the 35 licensed producers are not open yet, well over a year after being awarded a license to produce medical cannabis.

A plant count structure like in Option A or Option B, would bring the state of New Mexico and the Department of Health in compliance with the intent of the law and uphold the spirit of the Lynn and Erin Compassionate Use Act, 2007.  New Mexico’s medical cannabis history started in 1978.  After public hearings the legislature enacted H.B. 329, the nation’s first law recognizing the medical value of cannabis...the first law. The Department of Health should additional employ three staff members to provide medical cannabis health education statewide. The Department of Health should also establish a training and certification program for all dispensary employees.

For ensuring safe access to all areas of the the state of New Mexico and proper administering of the Lynn and Erin Compassionate Use Act, by the New Mexico State Department of Health can be achieved with “adequate supply” as follows:

    1. Adequate supply of medical cannabis properly defined, structured, and increased.
      1. Maximum quantity of usable cannabis increased to 425.243 grams per 3 months ( 2.5 ounces every two weeks ).                  
      2. Inclusion of empirical data for for determining adequate supply for varying amounts cannabis plant material needed to manufacture different forms of medical cannabis medicine for proper dosage.        

    1. Revisions to licensing requirements for MCP LNPP’s
      1. Plant count for patients & producers properly structured and increased.
      2. Cannabis CBD strains at ratio of;  1.5 thc  (or lower) : 1 cbd (or higher) not counted against patient/caregiver or LNPP allowable plant count.
      3. Clones and Cuttings provided to qualified patient / caregiver with a PPL by a LNPP’s not counted against LNPP allowable plant count.
      4. Plant Count that is based on ratio of patients to serve AND inclusion of empirical data for varying amounts cannabis plant material needed to manufacture different forms of medical cannabis medicine.  
        1. Patient / Caregiver PPL plant count increased to allow for 6 immature seedlings /clones / cuttings, 6 plants in vegetative stage, and 6 plants in flowering stage for total of 18 cannabis plants.
        2. The addition of Cooperative/Collective PPL’s
          1. Whereas Rules and Regulations for Personal Production License should additionally include:
            The Department shall issue a individual cultivation registration to a qualifying patient or their personal caregiver. No more than 10 qualified patients may collectively cultivate, and each participating patient must obtain a collective cultivation registration. The Department may deny a registration based on the provision of false information by the applicant. Such registration shall allow the qualifying patient or their personal caregiver to cultivate an area of limited square footage of plant canopy, sufficient to maintain a 90-day supply of cannabis, and shall require cultivation and storage only in a restricted access area.
            A qualifying patient or personal caregiver shall not be considered to be in possession of more than a 90-day supply at the location of a restricted access area used collectively by more than one patient, so long as the total amount of cannabis within the restricted access area is not more than a 90-supply for all the participating qualifying patients. A copy of each qualifying patient’s written recommendation shall be retained at the shared cultivation facility
          2. Qualified patients shall provide the following in order to be considered for a personal production license to produce medical cannabis:
            (1)  a description of the single indoor or outdoor location that shall be used in the production of cannabis;                
            (2)  a written plan that ensures that the cannabis production shall not be visible from the street or other public areas;
          3. (3)  a written acknowledgement that the applicant will ensure that all cannabis, cannabis-derived products and paraphernalia is accessible only by the applicant, collective members and/or their primary caregiver (if any), and kept secure and out of reach of children;
          4. (4)  a description of any device or series of devices that shall be used to provide security and proof of the secure grounds; and
            (5)  a written acknowledgement of the limitations of the right to use and possess cannabis for medical purposes in New Mexico.
          5. Cultivation facility” means a business that:
            1. Is registered with the Department of Agriculture; and (we should be having Dept. of Ag involved)
            2. Acquires, possesses, cultivates, harvests, dries, cures, trims, and packages cannabis and other related supplies for the purpose of delivery, transfer, transport, supply, or sales to:
            (a) dispensing facilities;
            (b) processing facilities;
            (c) manufacturing facilities;
            (d) other cultivation facilities;
            (e) research facilities.
            (f) independent testing laboratories.

        1. LNPP Plant Count maximum ratio of 3 cannabis plants per enrolled patient. Based on yearly program totals. Thus; 30,000 patients x 3 cannabis plants  = 90,000 cannabis plants / 35 LNPP = 2,571.43 max allowable cannabis plants per LNPP. ( Minimum standard set by MCAB / Plant Count adjusted yearly for program growth )
          1.    Plant count increase structured : 1000 plants by July 1st 2017 then 2000 by July 1st 2018 and then 571 by July 2019   
      1. Licensing fee structure changed and lowered.
        1. The department shall assess a nonrefundable fee not greater than five hundred dollars ($500) for processing an application for a new or renewal license.
        2. For a new or renewal processor license, medical wholesale license or medical retail license, the department shall charge an annual license fee of not more than two thousand dollars ($2,000).
        3. For a new or renewal production license, the department shall charge an annual license fee of:
          1. Fifteen thousand dollars ($15,000), if the producer will possess up to one hundred fifty cannabis plants;
          2. and an additional five thousand dollars ($5,000) for each additional fifty cannabis plants the producer will possess;
          3. Cannabis and HEMP CBD strains at ratio of;                            1.5 thc  (or lower) : 1 cbd (or higher) are not counted against patient/caregiver or LNPP allowable plant count.
          4. Clones and Cuttings provided to qualified patient / caregiver with a PPL by a LNPP’s are not counted against LNPP allowable plant count.
          5. provided, however, that the maximum fee charged for a new or renewal production license shall not exceed forty-five thousand dollars ($45,000) per LNPP.  The annual license fees provided for in this section are nonrefundable and shall be paid by upon the issuance of a license.
          6. Any resulting legalization of cannabis for adult recreational in the state of New Mexico, shall use a licensing fee structure; respectively, $4000 Annual Lic/$30,000 Production Lic/$7,500 per additional fifty cannabis plants.
            1. 7.10 percent of recreational cannabis sales are returned into the medical cannabis program to maintain and improve the program
      2. Licensure Limit Established: LNPP 1 Grow Location : 3 Store Fronts
        1. Current producers granted additional license per application review and program standards met
      3. Time Period for new producers to open; 90-120 (window) days Expected / Letter sent given final 45 days before forfeiture of license.
      4. The Department of Health shall employ 3 staff members to provide medical cannabis health education statewide. The Department of Health shall also establish a training or certification program for dispensary employees.


In order for the Department of Health Medical Cannabis Program to allow for the medical treatment of cannabis, the Department must properly have “adequate supply” and have it properly defined.  And for the Department to have “adequate supply” they would need to know the different amounts of plant material that goes into all the different types of medicine being produced. Dried cannabis flower (bud), pre-rolls, edibles, tinctures, topicals/salves, and concentrated forms of cannabis all require different amounts of cannabis plant material to produce. Adequate Supply can not have a set definition in the rules and regulations and needs to be reviewed to coincide with MCP growth and patient/caregiver needs. Adequate Supply should be reviewed quarterly (4 times per year) with a current census completed of qualified patients, caregivers and licensed non-profit producers.

(Ad·e·quate: (ˈadÉ™kwÉ™t/) adjective; satisfactory or acceptable in quality or quantity.
Sup·ply (səˈplÄ«/) verb; 1. make (something needed or wanted) available to someone; provide.
"the farm supplies apples to cider makers" or a noun; 1. a stock of a resource from which a person or place can be provided with the necessary amount of that resource.)

This is empirical data that has not been collected within the state’s medical cannabis program by the Department of Health. Therefore “adequate supply” can not be properly defined by the department by using unknown variables it has not collected. This further prevents the Department of Health from being able to set a proper plant count for each kind of licensed producer in the program for the means of achieving adequate supply within the medical cannabis program as required by law.

This is empirical data has been studied and researched by the state of Colorado by the Colorado Department of Revenue: “An assessment of physical and pharmacokinetic relationships in marijuana production and consumption in Colorado”.

How is the purpose of the law able to be fulfilled without knowing Adequate Supply and by preventing patients from properly treating themselves due to adequate supply limits?
Section 2. PURPOSE OF ACT.--The purpose of the Lynn and Erin Compassionate Use Act is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments.
“ARTICLE 2B. LYNN AND ERIN COMPASSIONATE USE ACT
N.M. Stat. Ann. § 26-2B-2 (2009)
    § 26-2B-2. Purpose of act
The purpose of the Lynn and Erin Compassionate Use Act [26-2B-1 NMSA 1978] is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments.
HISTORY: Laws 2007, ch. 210, § 2.
EFFECTIVE DATES. --Laws 2007, ch. 210, § 12 makes the act effective July 1, 2007.”

References
The solution provided above was derived from the following sources:
Americans For Safe Access [http://www.safeaccessnow.org/policy_shop], Colorado Medical Marijuana Program [https://www.colorado.gov/pacific/cdphe/medicalmarijuana], Colorado Department of Revenue- An assessment of physical and pharmacokinetic relationships in marijuana production and consumption in Colorado [https://www.colorado.gov/pacific/sites/default/files/MED%20Equivalency_Final%2008102015.pdf],  Cannabis Yields and Dosing by Chris Conrad (court qualified cannabis expert) [http://chrisconrad.com/], and the Hawaii Medical Cannabis Program-Medical Marijuana Dispensary Task Force Study 2015 [http://files.hawaii.gov/auditor/Reports/2014/14-12.pdf].


Appendix A: An Americans for Safe Access (ASA) national report was released on December 8th, 2016 and calls for an end to contradictions between federal and state guidelines with regard to medical cannabis policies. The Americans for Safe Access briefing book, “Medical Cannabis in America”, showing that not only do opiate related deaths drop an average of 24.8% in states with medical cannabis laws, the report also notes that the Department of Justice has spent an estimated $592 million to date in arrests, investigations, enforcement raids, pretrial services, incarceration, and probation.

Plant Count For Producers Based On Patient Population Growth For Adequate Supply Proposed: Legislators could easily solve this by looking to Americans For Safe Access for this policy.

About Americans for Safe Access.
The mission of Americans for Safe Access (ASA) is to ensure safe and legal access to cannabis for therapeutic use and research.  ASA was founded in 2002, by medical cannabis patient Steph Sherer, as a vehicle for patients to advocate for the acceptance of cannabis as medicine. With over 100,000 active members in all 50 states, ASA is the largest national member-based organization of patients, medical professionals, scientists and concerned citizens promoting safe and legal access to cannabis for therapeutic use and research. ASA works to overcome political, social and legal barriers by creating policies that improve access to medical cannabis for patients and researchers through legislation, education, litigation, research, grassroots empowerment, advocacy and services for patients, government's, medical professionals, and medical cannabis providers.

Appendix B: Plant Cap Example Based on Canopy from a Oregon Medical Cannabis Farmer.

Total Production Allowances
“With the OLCC’s stated goal for the Grower RAC of making, “individually licensed indoor,
outdoor and greenhouse annual finished product output roughly equivalent,” we must
consider a few key differentiating factors:
Variables:
Y. Expected Yield Per Flowering Canopy Type (Y=grams per sqft.)
A. Total Flowering Canopy “A”rea Cultivated (A=number of sqft)
R. “R”ounds that area will be flowered annually (R=flowering cycles)
At sofresh farms we cultivate medical cannabis for the OMMP/MMD program each of
the three primary ways: outdoors, greenhouse and indoor. Each market is distinct and
as the industry evolves we expect that the majority of growers will want to expand into
each of these unique Oregon cannabis markets. For example, many outdoor crops are
being planted for processing—“soil to oil”; while greenhouse flowers can straddle the
two markets depending on the infrastructure invested and the location of the
green/hothouse. The indoor market is primarily focused on trophy winning flowers.

Surprising to some, based on our growing experiences and extensive dialog at Oregon’s
Finest MMD and throughout the state with many experienced indoor, greenhouse and
outdoor growers—there is very little difference in expected yield per sqft of growing
area between the different disciplines, if similar cultivation techniques are applied in
each growing environment. So if our first variable, Y. “Expected Yield Per Area” is
approximately equal across all growing disciplines and the OLCC can meaningfully
regulate the second variable, A. “Total area cultivated” by requiring all applicants to
submit a farm/floor plan that clearly illustrates the “sqft of flowering canopy area
cultivated”. Then, all we are left to determine to help solve the OLCC’s stated goal is,
variable R, “How many times that area will be flowered annually”.

Outdoor is typically flowered ONE time annually. (May to November) Yes, it is feasible to deprive the light cycle (light-dep.) to start flowering without a greenhouse structure causing an outdoor crop to flower twice in Oregon’s climate but this is not common and should be the exception
not the rule. Some growers that use a simple “hoop house” and poly film to keep the rain off the flowers would also be classified as outdoor. Greenhouse/hothouse is typically flowered TWO times annually. (February to November)

The majority of “greenhouse” growers in Oregon do so with a “hoop house” and would fall under the Outdoor category because they only flower once annually. Many of Oregon’s cannabis cultivators are moving to greenhouses because they want to take advantage of the
ability to begin flowering cannabis under the sun when the days exceed longer than 12 hours in April and May. This is most commonly done with small amounts of supplemental lighting and light-deprivation tarps to force flowering and a supplemental heat source to help extend the
growing season during the cool spring and fall nights. Some hothouses are more similar to indoor operations when it comes to equipment and technology and can pull off a third round in the short winter months with artificial lighting, but this is not common and should be the exception not the rule.

Indoor is typically flowered FOUR times annually. (Year Round) Most hybrid genotypes (strains) that are popular to cultivate in Oregon take 8 to 9 weeks to complete their flower cycle under 12 hours of
light. Yes, some indoor growers pull 6 rounds annually which is the maximum possible number of times it is possible to turn the inventory in a flowering room—easy to do on a spreadsheet but more difficult in reality. 6 rounds is not common and should be the exception not the rule. When taking into consideration the seasonality of air-cooled indoor rooms, down time for cleaning/maintenance and the need to spend a few weeks of flower room space for 18 hour per day vegetative
growth it is much more realistic to expect 4 times annually—13 week indoor “round” (9 weeks flower/4 weeks veg).

Knowing that as soon as I wrote this someone growing 4 plants somewhere in Oregon
came up with a totally new way to grow cannabis that isn’t included…the key to this, “ONE, TWO, FOUR formula” below is to use it as a rule of thumb guideline to measure if the actual output of growers’ compared to the OLCC’s stated goal of making indoor, outdoor and greenhouse cultivation models roughly equivalent to each other. Every cannabis operation is unique and I am sure that any grower could provide different examples, as could I, but generally if the goal is to solve for the total annual yield by cultivation discipline then we can conclude with a recap that we solve for the variables like so:
Y. “Expected Yield Per Unit of Flowering Canopy Area” is approximately the same yield per sqft in a greenhouse, outdoors or in a warehouse when similar cultivation practices are employed.
A. “Total Flowering Canopy Area” cultivated is licensed by the OLCC and should be reported in the initial applicants farm/floor plan; this total area limit increase over time could be based on a producers ability to prove legal sales records for the area that is cultivated.
R. How many times that area will be flowered annually “Rounds” is determined by cultivation method, outdoor is generally once a year, greenhouse twice and indoor four times—on average.
Formula:
R * A * Y = Total annual yield

Basically the formula says that if an indoor grow is 10k sqft of flowering canopy then a greenhouse would be 20k sqft and an outdoor farm would be 40k sqft.

Appendix C: The Cannabis Plant Compared To Common Plants In New Mexico.

Did you know that household plants are one of the leading causes of poisoning in children?
Some plants have substances that can cause symptoms ranging from a mild stomachache to
serious illness or even death. That is why it is important to know what kind of plants are in and around your home and whether they will cause serious illness if touched or eaten. According to UNM- College of Pharmacy, these plants are commonly found in New Mexico and are highly toxic (can cause very serious illness & even death). Poisonous Plants in New Mexico: jimson weed, oleander, foxglove, and poison oak. The complete list of common poisonous plants in New Mexico has over 50 different plant species on it. Cannabis in general and the strain, hemp, is not on any such list anywhere.


Lynn & Erin Compassionate Use Act Patient’s Coalition of New Mexico ~ A GrassRoots Movement!
UNITE-NETWORK-GROW-INFORM-KNOW-EDUCATE-ACTIVISM-VOTE-HEALTH-WELLNESS
(All Rights Reserved 04/20/2016)

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